http://www.bjj.boneandjoint.org.uk/content/96-B/1/88.abstract

Survival analysis of elderly patients with a fracture of the odontoid peg

1. M. Venkatesan, MBBS, PG Cert (Applied Health Sciences), Trauma Fellow1 ; 
2. J. R. Northover, FRCS(Tr & Orth), Specialist Registrar1;
3. J. B. Wild, MRCS, Core Trainee1; 
4. N. Johnson, MRCS, Specialist Registrar1; 
5. K. Lee, MRCS, Core Trainee1; 
6. C. E. Uzoigwe, MRCS, Specialist Registrar1; and 
7. J. R. Braybrooke, FRCS(Tr & Orth), Consultant Orthopaedic and Spine Surgeon1

+Author Affiliations

1. 1University Hospitals of Leicester, Infirmary Square, Leicester LE1 5WW, UK.

1. Correspondence should be sent to Mr M. Venkatesan; e-mail:muraliv@doctors.org.uk

Abstract

Fractures of the odontoid peg are common spinal injuries in the elderly. This study compares the survivorship of a cohort of elderly patients with an isolated fracture of the odontoid peg versus that of patients who have sustained a fracture of the hip or wrist. A six-year retrospective analysis was performed on all patients aged > 65 years who were admitted to our spinal unit with an isolated fracture of the odontoid peg. A Kaplan–Meier table was used to analyse survivorship from the date of fracture, which was compared with the survivorship of similar age-matched cohorts of 702 consecutive patients with a fracture of the hip and 221 consecutive patients with a fracture of the wrist.

A total of 32 patients with an isolated odontoid fracture were identified. The rate of mortality was 37.5% (n = 12) at one year. The period of greatest mortality was within the first 12 weeks. Time made a lesser contribution from then to one year, and there was no impact of time on the rate of mortality thereafter. The rate of mortality at one year was 41.2% for male patients (7 of 17) compared with 33.3% for females (5 of 15).

The rate of mortality at one year was 32% (225 of 702) for patients with a fracture of the hip and 4% (9 of 221) for those with a fracture of the wrist. There was no statistically significant difference in the rate of mortality following a hip fracture and an odontoid peg fracture (p = 0.95). However, the survivorship of the wrist fracture group was much better than that of the odontoid peg fracture group (p < 0.001). Thus, a fracture of the odontoid peg in the elderly is not a benign injury and is associated with a high rate of mortality, especially in the first three months after the injury.

Cite this article: Bone Joint J 2014;96-B:88–93.

Footnotes

• No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
  This article was primary edited by S. Hughes and first-proof edited by J. Scott.

• Received March 16, 2013.
• Accepted September 5, 2013.

• ©2014 The British Editorial Society of Bone & Joint Surgery